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The application of minimally invasive tracheostomy in critical patients

Chinese Journal of Minimally Invasive Surgery.2001;0(01):-.

Objective To study the application of percutaneous dilatational tracheostomy in the critical pa- tient. Methods Twenty eight critical patients performed percutaneous dilatational tracheostomy have been followed up in our hospital during 1996 - 2000, and the operating time, the perioperative complications and the following - up results were reviewed. Results all of the 28 patients were operated on successfully,no complication occurred dur- ing the operation , and little bleeding was observed, most of the patients have been followed up, the longest following - up period was 18 months, and the cosmetic effect was good. Conclusions The percutaneous dilatational tracheo- somy is a good less invasive surgical technique. It can meet the needs of the clinical tasks and worth to apply to some critical area.

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A new method of arthroscopic total meniscectomy (a report of 169 cases)

Jianquan WANG ; Yingfang AO ; Yaolin HU

Chinese Journal of Minimally Invasive Surgery.2001;0(01):-.

Objective To research for a new method of arthroscopic total meniscectomy with simple instru- ments. Methods One hundred and sixty nine cases were followed up for short period that had been operated on with a forward knife, a back cutting knife, a punch and a 30?scope from Nov. 1992. to Aug. 1998. Results The av- erage time of operation was 78 minutes. The operations had no injury to cartilage and ligament. It is necessary for only 7 .9 percent of patients to take analgesic intramuscularly after operation. Eight patients had a transient tourniquet paral- ysis. All of them could begin to work and exercise after postoperative 2 weeks. Conclusion As compared with the method introduced by David Sisk ,this method has the advantages of simple instruments, fewer ports and complications and minimal trauma Either lateral meniscus or medial meniscus can be cut off by the same method. This method is a safety and a better way to arthroscopic meniscectomy.

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Arthroscopic-assisted anterior cruciate ligament reconstruction

Yingfang AO ; Jianquan WANG ; Jiakuo YU

Chinese Journal of Minimally Invasive Surgery.2001;0(01):-.

In oder to make the bone tunnel in optimal position, effective and firm fixation, early functional recov- ery and minimally operative injury we reported a new technique in reconstructive anterior cruciate ligament(ACL)using patellar tendon autograft fixed with interference screw. With the assistance of arthroscopy 74 patients with ACL rupture were treated between October 1997 and April 1999. The clinical results showed that the operative injury was minimal, fixed bone grafts were accurate and the reconstructed ACL was isometricity. The reconstructed ligament could be fixed biologically and firmly because of used patellor tendon autograft with bone grafts at two end. Clinical experience of ar- throscopic - assisted ACL reconstruction was summarized.

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The treatment for acute variceal hemorrhage of patients with Child class C cirrhosis

Tonglin ZHANG ; Guoxin LI ; Gang WANG

Chinese Journal of Minimally Invasive Surgery.2001;0(01):-.

Objective To seek an effective and safe therapy for acute variceal hemorrhage of patients with Child class C cirrhosis. Methods One hundred and nine Child class C cirrhotic patients with an acute hemorrhage from esophageal varices were reviewed. Sixty - one patients received medical therapy;29 patients were underwent sur- gical operations and 19 patients received TIPSS. Results The surgical group had a higher mortality rate during hos- pitalization(65. 5 % ) than either of the other groups(36. 1 % and 26. 3 % respectively ). The rebleeding rates during hospitalization were 24. 1 %, 36. 1 % and 15. 8 % respectively in the surgical group, medical group and TIPSS group. Rebleeding rate during following- up period were 33. 0%, 36. 1 % and 21 .4% respectively. The rebleeding rate was significantly higher in the medical group than that in either of the other groups during the two phases. Kaplan - Meier survival analysis didn' t show significant difference among the three groups. Conclusions The results showed that TIPSS is a good alternative to surgical or medical therapy for patients with Child class C cirrhosis and acute vericeal bleeding.

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Sympathectomy for Raynaud disease

Guoxiang DONG ; Nengwei ZHANG ; Jun ZHAO

Chinese Journal of Minimally Invasive Surgery.2001;0(01):-.

Objective To study the effect of thoracoscopic sympathectomy and/or chemical lumbar sympa- thectomy performed on patients with Raynaud disease. Methods Five patients, 1 male,4 females, aged from 30 to 65(mean 45. 3 ). Raynaud phenomenon appeared only on both hands in one patient, only on feet with a toe gangrene in another one , the other 3 cases on all limbs. Thoracoscopic symathectomy was performed for those whose hands were af- fected and chemical lumbar sympathectomy(12-3 ) was pererformed for those whose feet were affected. Results All patients were followed up from 12 to 48 months(mean 24 months). All experinced improvement with hands warm and satisfactory results after thoracoscopic sympathectomy. However, the original symptoms reccurred in two patients after postoperatire six months. All 4 patients performed chemical lumbar sympathectomy experienced improved symptoms with feet warm and satisfactory results and the symptoms did not recur up to now. The sympathectomy showed different results for hands and for feet. Conclusions Thoracoscopic sympathectomy for hands affected by Raynaud disease has efficiency temporarily, but is not satisfactory. The chemical lumbar sympathectomy for the feet affected by Raynaud disease has dramatically disappearence of symptoms and the results are very good

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Combined minimally invasive approaches with conventional surgery for critical extremity ischemia

Changwei LIU ; Heng CUAN ; Yongjun LI

Chinese Journal of Minimally Invasive Surgery.2001;0(01):-.

Objective To evaluate our early results of a combined minimally invasive surgery with surgical procedures for critical extremity ischemia. Methods From July 1999 to October 2000 intraluminal iliac minimally invasive surgery combined with simultaneous conventional surgery were performed on 20 lower extremities of 15 pa- tients suffering from critical multilevel atherosclerotic occlusive disease. There were 11 men and 4 women with an aver- age age of 73 years. The indications for surgery included disabling claudication in 6, rest pain in 9(included tissue gan- grenes in 3)patients. Mean preoperative ankle - brachial index(ABI)was 0. 35 ? 0. 18. Results 17 iliac mini mal- ly invasive approaches combined with simultaneous 11 femoro - popliteal bypass and 3 femoro - femoral popliteal by- pass as well as 5 profundaplasty were performed in 20 limbs of 15 patients. minimally invasive surgery were technically successful in all patients. One femoral - popopliteal bypass was failure. There were no additional instances of procedural or postoperative morbidity or mortality, and no wound - related complications. Postoperative ABI of femoral - popliteal bypass was 0.74 ? 0. 16(p

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A comparison of therapeutic effect and cost between subaxillary minithoracotomy and video - assisted thoracic surgery(VATS) for treatment of spontaneous pneumothorax

Zhenyun SHEN ; Dandan LIU ; Zheng LIANG

Chinese Journal of Minimally Invasive Surgery.2001;0(02):-.

0.05), respectively; 10 cases out of 12 cases performed SAMT and 26 cases out of 33 cases per- formed VATS were operated bullaectomy; the number of recurrence after operation was 2 in VATS and none in SAMT; the average operative cost was ￥ 806 ? 78 in SAMT and ￥ l808 + 447 in VATS(t = 7 .6,P

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Shengshou HU ; Zhitao QI ; Yunhu SONG

Chinese Journal of Minimally Invasive Surgery.2001;0(02):-.

Objective To determine the factors affecting valve replacement through mini - sternotomy. Methods 35 patients underwent mitral valvular replacement (MVR, 23 cases) or bivalvular replacement (BVR, 12 cases) through minimal sternotomy. 19 cases were male and l6 cases were female. The age ranged from 21 to 62 years with an average(44 ? 9) years. The factors affecting the aorta clamped time (ACT) and the cardiopulmonary by- pass time (CPBT) ware analyzed. Results When the left ventricular diastolic diameter was more than 60mm, ACT and CPBT were longer in MVR and were shorter in BVR. ACT and CPBT were almost significantly longer in MVR and AVR when superior margin of manubrium was lower than the fifth thoracic vertebra. Height of aortic node, cardiotho- racic ratio, diameter of left artia and aortic root were not related with ACT and CPBT. Conclusion Larger left ventricular and lower manubrium may be the related factors that affecting the operation of valvular replacement.

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A report on 102 laparoscopic cholecystectomies using suture and knot instrument in the abdominal cavity

Guoxiang LI ; Mingxin HE ; Xiaohong LUO

Chinese Journal of Minimally Invasive Surgery.2001;0(02):-.

Objective To evaluate the security and the reliability of ligating the cystic duct and the cystic ar- tery with common silk suture as the substitute for titanic or biological clamps in laparoscopic cholecystectomy (LC) us- ing the suture and knot instrument developed by the authors. Methods One hundred and two laparoscopic chole- cystectomies were performed by the authors using the instrument. Results All patients were discharged in the post- operative fourth or fifth day without any complication. Conclusion The instrument used for LC was safe and reliable.

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Anatomy of cystic artery variant with video laparoscopic cholecystectomy and its significance

Chihua FANG

Chinese Journal of Minimally Invasive Surgery.2001;0(02):-.

Objective To study variant artery and treatment under video laparoscopic cholecystectomy(LC). Methods 521 patients who received selective cholecystectomy(male 159 patients and female 362 patients, aged 11 to 76 years),were operated on with video laparoscopy. Cystic artery was anatomized under general anesthesia and carbon dioxide pneumoperitoneum. Results Variant Cystic artery presented in 140 patients(26 .9% ). Cystic artery of 60 patients originated from anterior or posterior common bile duct, single cystic artery was in 3 patients, double cys- tic artery in 51 patients, cystic artery arose from celiac artery was in 6 patients, cystic body artery existed in 17 pa- tients and cystic artery originated from variant right hepatic artery in 3 patients. Conclusion Variant cystic artery is very common. Correct recognition, dissection and safe treatment are an important to prevent hemorrhage and bile duct injuries during laparoscopic cholcystectomy.

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